Vesical exstrophy is a rare congenital anomaly for which surgical management is still a challenge. A modified new conservative surgical approachentailingbladderandurethral reconstruction using microsurgical techniques was utilized. The operation was carried out in one stage without bony mutilation. The operation was done in twenty-one patients who were followed up for one to fifteen years. The results in most of the cases were satisfactory and none of the patients required urinary diversion